Korean Circ J.  2008 Feb;38(2):101-109. 10.4070/kcj.2008.38.2.101.

The Comparative Clinical Effects of Valsartan and Ramipril in Patients With Heart Failure

• Lee KH
• Jeong MH
• Ahn YK
• Lee WS
• Jung DH
• Cho JG
• Park JC
• Kang JC
• Oh SK
• Kim NH
• Yun KH
• Yoo NJ
• Moon Y
• Rhew JY
• Lim JH
• Jeon SH
• Park OY
• Lee SU
• Kang DG

• KMID: 2225846
• DOI: http://doi.org/10.4070/kcj.2008.38.2.101

Abstract

BACKGROUND AND OBJECTIVES
Angiotensin II receptor blocker (ARB) has emerged as an alternative to angiotensin converting enzyme inhibitor (ACEI) for the treatment of heart failure. This study aimed at comparing the effectiveness and safety of valsartan with ramipril in patients with heart failure, and these patients were hospitalized at Chonnam National University Hospital, Wonkwang University Hospital, Gunsan Medical Center, Presbyterian Medical Center, Seonam University Hospital and Gwangju Christian Hospital.
SUBJECTS AND METHODS
Between March 2005 and March 2007, 82 patients (60.5+/-12.4 years, 59 males) who complained of class II to IV dyspnea, according to the New York Heart Association (NYHA) classification, and who had low left ventricular ejection fraction (LVEF) less than 50% were randomly allocated to valsartan or ramipril. After 6 months, the clinical symptoms, vital signs, biochemical tests and echocardiography were compared between the two groups.
RESULTS
The NYHA class was improved in both groups (the valsartan group: 2.31+/-0.51 vs. 1.46+/-0.58, p<0.001; the ramipril group: 2.21+/-0.55 vs. 1.61+/-0.50, p<0.001). The incidence of cough, as measured by the cough index, was significantly lower in the valsartan group than in the ramipril group (p=0.045). The LVEF was improved in both groups (the valsartan group: 36.4+/-8.5% vs. 46.9+/-12.9%, p<0.001; the ramipril group: 35.1+/-8.5% vs. 45.3+/-11.2%, p<0.001). The improvements of the left ventricular end-systolic dimension (p=0.754) and end-diastolic dimension (p=0.998) were not different between the two groups. N-terminal Pro-B-type natriuretic peptide level was improved in both groups (the valsartan group: 2619.6+/-4213.5 vs. 995.4+/-2186.0 pg/mL, p=0.012; the ramipril group: 3267.9+/-4320.0 vs. 828.1+/-1232.8 pg/mL, p=0.009), and there was no difference between the groups (p=0.877).
CONCLUSION
Both valsartan and ramipril were effective treatments, with relatively low adverse events, in patients with heart failure.

Keyword

Heart failure; Angiotensin; Ventricular remodeling

MeSH Terms

Angiotensins
Cough
Dyspnea
Echocardiography
Heart
Heart Failure
Humans
Incidence
New York
Peptidyl-Dipeptidase A
Protestantism
Ramipril
Receptors, Angiotensin
Stroke Volume
Tetrazoles
Valine
Ventricular Remodeling
Vital Signs
Valsartan
Angiotensins
Peptidyl-Dipeptidase A
Ramipril
Receptors, Angiotensin
Tetrazoles
Valine

Figure

• 

  Fig. 1 Changes of clinical symptoms. A: changes of New York Heart Association functional class. B: changes of cough index. Cough index is the sum of cough score for each visit divided by the number of patients who complained cough. Cough score is defined as: 0=none, 1=mild, 2=moderate, 3=severe, 4=very severe. *p<0.001 basal state vs. 6 month analyzed by repeated measures ANOVA, †p valsartan vs. ramipril group. ANOVA: analysis of variance.

• 

  Fig. 2 Changes of echocardiographic findings between valsartan and ramipril groups. A: left ventricular ejection fraction. B: left ventricular end systolic dimension. C: left ventricular end diastolic dimension.

• 

  Fig. 3 Changes of laboratory findings between valsartan and ramipril groups. A: changes of N-terminal Pro-B-type natriuretic peptide (NT-proBNP). B: changes of serum glucose.

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  Fig. 4 N-terminal Pro-B-type natriuretic peptide (NT-proBNP) according to NYHA class. NYHA: New York Heart Association.

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